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� f <br /> BUSINESS CERTIFICATE# <br /> ;y <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE 13 <br /> Expiration Date: �� Z�/ <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby declare(s) that a business under the title of <br /> Business Name/DBA: 1 A V-e 'C +NN 10C- Name: <br /> is conducted at Business Location: r Commercial—Residential <br /> Business Mailing Address: '/ 1 �j fd-i D le <br /> Business�Type: .242-f- s%' Ef Business Telephone: / _r 0e .I—.3 f obi 7 <br /> Nett' l `" Renewal' Home Phone: Jloi ' S S q-6)0 _3 Email Address: & LK cQ t r C- m . C a <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> �eS� fr4 L �(i2r �.f.✓S�� //�1 Stlo,EL .)2 11,4sweCc o26 ,/-9 <br /> I certify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes as required under law. <br /> *Signature of authorized agent "Social Security Number(Voluntary) <br /> • or Federal Identification Number <br /> "This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <br /> "Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will he subject to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Couuaanwealth of Massachusetts BARNSI'ABLE ss llDATEPersonally appeared before me the above-nanmed &rZ4"'A �`le/ Z frA)-SK y and made oath that the foregoing statement is <br /> true. ' <br /> A certificate issued in accordance with this section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> t / No ublic <br /> SEAL <br /> • _- . . In I fres: <br /> �Q'000W Fir <br />